A nurse-led, home-based intervention significantly reduced all-cause mortality compared to usual care (77% vs 89%; adjusted RR 0.74; 95% CI 0.53-0.80; P<0.001) over up to 10 years of follow-up.
RCT (n=297)
Effect estimate: adjusted RR 0.74 (95% CI 0.53-0.80)
Absolute Event Rate: 77% vs 89%
p-value: p=<0.001
BACKGROUND: The long-term impact of chronic heart failure management programs over the typical life span of affected individuals is unknown. METHODS AND RESULTS: The effects of a nurse-led, multidisciplinary, home-based intervention (HBI) in a typically elderly cohort of patients with chronic heart failure initially randomized to either HBI (n=149) or usual postdischarge care (UC) (n=148) after a short-term hospitalization were studied for up to 10 years of follow-up (minimum 7.5 years of follow-up). Study end points were all-cause mortality, event-free survival (event was defined as death or unplanned hospitalization), recurrent hospital stay, and cost per life-year gained. Median survival in the HBI cohort was almost twice that of UC (40 versus 22 months; P<0.001), with fewer deaths overall (HBI, 77% versus 89%; adjusted relative risk, 0.74; 95% CI, 0.53 to 0.80; P<0.001). HBI was associated with prolonged event-free survival (median, 7 versus 4 months; P<0.01). HBI patients had more unplanned readmissions (560 versus 550) but took 7 years to overtake UC; the rates of readmission (2.04+/-3.23 versus 3.66+/-7.62 admissions; P<0.05) and related hospital stay (14.8+/-23.0 versus 28.4+/-53.4 days per patient per year; P<0.05) were significantly lower in the HBI group. HBI was associated with 120 more life-years per 100 patients treated compared with UC (405 versus 285 years) at a cost of 1729 dollars per additional life-year gained when we accounted for healthcare costs including the HBI. CONCLUSIONS: In altering the natural history of chronic heart failure relative to UC (via prolonged survival and reduced frequency of recurrent hospitalization), HBI is a remarkably cost- and time-effective strategy over the longer term.
Inglis et al. (Tue,) conducted a rct in Chronic heart failure (n=297). Nurse-led, multidisciplinary, home-based intervention (HBI) vs. Usual postdischarge care (UC) was evaluated on All-cause mortality (adjusted RR 0.74, 95% CI 0.53-0.80, p=<0.001). A nurse-led, home-based intervention significantly reduced all-cause mortality compared to usual care (77% vs 89%; adjusted RR 0.74; 95% CI 0.53-0.80; P<0.001) over up to 10 years of follow-up.